Hyperprolactinemia, Induced by Antipsychotics and Resistant to Cabergoline Therapy

Background: hyperprolactinemia is common in patients with mental disorders receiving antipsychotics. Cabergoline therapy for normalizing prolactin in these patients has been found to be effective. Cases of prolactin-secreting pituitary adenomas resistant to cabergoline have been described in the literature. Clinical observations of antipsychotic-induced/antipsychoticassociated hyperprolactinemia resistant to cabergoline therapy are rare in scientific publications.

The aim of the study was to describe clinical cases and justify treatment approaches to hyperprolactinemia, associated with antipsychotics and resistant to cabergoline therapy.

Patients and Methods: the study involved female patients with endogenous mental disorders undergoing inpatient treatment. Clinical, psychopathological, and laboratory examination methods were used. Case description: Case 1 — a 23-year-old female, mentally ill since the age of 17, was twice treated in mental hospitals for a depressive state within the framework of schizotypal disorder. A severe course of depression with a high risk of suicide and clear resistance to drug therapy was noted; a course of ECT was administered. The therapeutic effect was achieved through the use of antipsychotics, but an increase in prolactin levels was detected. Hyperprolactinemia was accompanied by weight gain, lactorrhea, and hair loss. Cabergoline at a dose of 3.5 mg per week was ineffective. With the correction of antipsychotic therapy, the level of prolactin in the blood returned to normal. Case 2 — a 37-year-old female, mentally ill since the age of 19, was repeatedly treated in mental hospitals for hallucinatory-delusional symptoms. Chronicity of the disease and pronounced resistance to drug treatment were noted. A course of ECT was administered to overcome resistance. Prescription of antipsychotics resulted in a significant reduction in hallucinatory-delusional symptoms and improvement in the patient's quality of life; however, the development of hyperprolactinemia was detected. Cabergoline at a dose of 3.5 mg per week was ineffective. Hyperprolactinemia was virtually asymptomatic (including the absence of hypogonadism), cabergoline was terminated, and psychopharmacotherapy was continued according to the previous treatment regimen.

Conclusion: if cabergoline 3.0 mg/week is ineffective, antipsychotic-induced/ antipsychotic-associated hyperprolactinemia may be considered cabergoline-resistant. The choice of treatment tactics in this case should be carried out individually, taking into account the clinical manifestations of hyperprolactinemia, a comprehensive analysis of laboratory parameters, and the specificities of the course of the mental disorder.

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